Apparently all of this talk of universal healthcare on the campaign trail has got the insurance companies a little nervous. Good.

Eh, I don't know if it's _that_ or desire to have a better supply of generics because it gives them reason to deny coverage of brand name drugs. For example for Blue Cross Blue Shield some plans have this Member Pays the Difference: https://www.bcbstx.com/pdf/rx/member-pa ... nce-tx.pdf

"You will pay the copay/coinsurance amount plus the difference in cost between the brand drug and its generic equivalent"

So, basically, they save money themselves. And maybe make their insured ever so slightly less pissed off.

I do wonder what would happen if we do switch to universal healthcare -- would we be able to invest into generics manufacturer without never-ending flurry of lawsuits

What is to stop the company from releasing drugs at just under what the cheapest drugs are at, and then selling them for that price? Does BCBS get a cut of the profits from the drugs that are manufactured? If even 10% of the cost of the drug is given back to BCBS, then if they sell a drug for $100, they get $10 back... For the same drug they purchased and made. And then if other insurance providers pay for the same drugs, BCBS gets the 10% from them too.

I understand the company was created because of the price increases, but I think there is also the bottom line that will eventually be what the Board will stress.

Will this turn into the Insurance companies all getting into the game of partnering with drug companies to make the drugs and get a part of the profits? If so, then what is to stop them from price gouging and reaping the rewards.

Like many things involving insurance and US healthcare... I remain cautiously... um... hopeful? But realistically bummed at what will inevitably happen.

Maybe I am just pessimistic about the world. But with the track record - FCC shenanigans, IoT products becoming bricks, the current farce in the White House and the current proceedings - it is hard for me to be optimistic.

Disclaimer: I work in pharmaceutical drug pricing and reimbursement

CivicaRx works differently from other drug manufacturers because it is not actually a manufacturer - at this stage they are in drug manufacturing contracting and re-labeling. Manufacturing takes years to set up, and the company has not yet determined that it is necessary to go into production on its own. Instead what it does is identify drugs that have gone up in pricing or are in shortage due to reasons other than ingredient shortages, and contracts with manufacturers to establish a steady supply at a transparent price. Generic drug manufacturers stop producing drugs when they are no longer assured of enough demand to make production profitable. CivicaRx addresses this by having it's 1200+ member hospitals agree to purchase the drugs produced under contract. Both sides benefit - hospitals get a sure supply of low-cost medication while the manufacturer gets a multi-year purchase guarantee to keep the production lines rolling.

The hospitals and BCBS aren't looking to profit from this venture - this is about establishing a reliable supply and a low, transparent price. Other manufacturers may lower their prices below what CivicaRx is charging, but there is no guarantee those prices will remain low or that the products will continue to be made. So BCBS isn't looking to make $$ on each sale, but instead to SAVE money on the use of drugs in the hospital setting. While CivicaRx may eventually expand its product availability to other providers, at the moment they are focused on the hospital setting. Remember that Civica is a non-profit - their focus is not on making money but instead on ensuring adequate supplies at reasonable prices.

As to your question about insurance companies partnering with manufacturers - this already happened in the past. A lot of PBMs (pharmacy benefit managers) originated with drug manufacturers, and those that didn't start their own bought them. The FTC started investigating this in the 90s, however, and so seeing the writing on the wall all the drug companies divested themselves of their PBM subsidiaries. Whether or not the government would let a manufacturer own a PBM or vice-versa is probably less of a concern, however, as no PBM would want to own a manufacturer. PBMs make the most money by playing drug manufacturers against each other, and generic drug manufacturing is not a low-riskm high-margin business.

Instead we've seen PBMs partner with wholesalers to form buying groups to source generic drugs at discount prices. The two major programs are Red Oak Sourcing, owned by CVS/Health and Cardinal Health, and Alliance Boots Development owned by Walgreens and AmeriSourceBergen, which also includes participation from Express Scripts. Walmart also has a program with McKesson. Between these three programs you have the three biggest biggest retail pharmacy chains and three largest drug wholesalers, as well as the two biggest PBMs. Insurance companies are already part of these arrangements due to Express Scripts being owned by Cigna as of last year and CVS/Health's acquisition of Aetna. In addition, Anthem uses CVS/Health for it's PBM backend.

I am all for less expensive medication but I am not a fan of generics because the quality is not the same. I'll give an example : I used to take Lipitor prior to the expiration of its patent. After the patent expired I began taking the generic substitute. With no other changes to medication or diet my glucose levels shot through the roof and I was prescribed an anti-diabetes medicine I can't remember the name of now. That led to a another change in medication that does not affect my glucose levels. I asked my doctor what was up with that and he said that is common with generic medications because they are usually made in India or China where the quality control is somewhere between lax and non-existent.

I am not convinced generic medication is really the answer but something certainly has to be done.

Here in the UK, generics are extremely common and made in places like India and Malta. I have never heard of any problems. Tell me, does you doctor ever get freebies from pharma companies?Spreading FUD was the IBM way of dealing with competition from more efficient vendors. In the long term it hasn't actually worked that well for them.

Apparently all of this talk of universal healthcare on the campaign trail has got the insurance companies a little nervous. Good.

Eh, I don't know if it's _that_ or desire to have a better supply of generics because it gives them reason to deny coverage of brand name drugs. For example for Blue Cross Blue Shield some plans have this Member Pays the Difference: https://www.bcbstx.com/pdf/rx/member-pa ... nce-tx.pdf

"You will pay the copay/coinsurance amount plus the difference in cost between the brand drug and its generic equivalent"

So, basically, they save money themselves. And maybe make their insured ever so slightly less pissed off.

I do wonder what would happen if we do switch to universal healthcare -- would we be able to invest into generics manufacturer without never-ending flurry of lawsuits

Deal with regulatory capture by the FDA and deal with the idea that you can patent mixing two 'out of patent' medicines.The government can change laws, you know. It is not legally obligated to consider the business model of exploitative corporations as sacrosanct; that would be actual Fascism.

SOP for pharmacuital companies at this point is to use a mix of advertising to convince people to not use the generic and "coupons" to make their drugs $0 or even negative-cost to consumers until the competition goes under due to lack of sales.

Indeed: if I'm charging $500/vial for insulin, and you are insured, and your co-pay is $50; I can send you a $100 rebate and come out $400 ahead.

Why would you buy the generic, even if it's free, when mine is -$50 and heavily advertised?

Elect an administration that acts on those anti-competitive practices, and a Congress that won't stonewall the enforcement.

Elect an administration that nationalizes health care and the problem goes away forever (because another administration can change those laws if people are retarded enough to do again what they did in electing this administration).

In fairness, this issue isn't solely on our current administration. It's on the willingness of the parties to go along with pharmaceutical lobby money. Hence why we need to nationalize the whole fucking thing.

You don't lobby for advantages when you don't have a private business to lobby for.

I've been dealing with clinical depression most of my life. My doctor and I finally found a new drug that worked well for me and I was on the right track for recovery. Then randomly when I went in for a refill the price for the drug changed from free, to 900 dollars, because my insurance reclassified it. Now I am in the process of weaning off it because I can't afford it.

Burn them down.

You understand it was most likely your employer that told them to do that, no?

oh PLEASE! another gambit by the very profiteers making a bundle off every hapless, diseased and sickened 'patients' who have NO OTHER SOURCE for the most basic generics flying off the shelves at every corner shop drug dispensary.

lower the cost for THE HIGHEST MARKED UP items? what a complete scam, even with the clever sounds of 'GENERIC' woven into this 'cross business industry' complicity!

NO, i'm not a skeptic, i am convinced these huge monstrous organizations are out to screw as many littl folks they can drag into their grubby mitts.

the scale of s$ale$s these pharma-cartels and their complicit pals in the 'extortionist insurance' industry is so vast, it outweighs the regulatory capacity of any simple goodie two shoes appointee that gets shovelled in by some vote mongering political thug/under the table wind bag.

there will be little or nothing for the average aspirin popping survivors to gain from this.

custom made drugs, specially derived for specific use/off target or tailored for some wealth group of DNA targeted disease/defectives......?

if money isnt in the future for them, they will continue as before, DO NOTHING, complain about how much $$ they have "lost' on prior research (often done under GOVERNMENT GRANTS) and failed to prove worthy for massive sales.

bah, if only these harpys would get sick enough to actually feel pain.....

I’m gonna go with you didn’t even read the article. Otherwise you would have seen a good chuck of these are philanthropic and non-profit organizations.

The pharmaceutical industry has forfeited any right to their patent portfolios - especially those based on publicly funded research at universities.Put all patents older than 5 years in the public domain, and bring on the generics.

This has nothing to do with patents anymore. Generic drugs are generic because the patents have expired. The problem is that the cost of entry into the drug manufacturing market is ENORMOUS, and there are built-in regulatory barriers to entry that can be raised by unscrupulous pharmaceutical manufacturers.

For example, all generic drugs must be tested and approved as "equivalent to the approved agent" by the FDA before they can be given to people. This testing, of course, is paid for by the new generic manufacturer and is costly all on its own. What some pharma companies have taken to doing, however, is making the originally FDA approved agent INCREDIBLY DIFFICULT for the new generic manufacturer to obtain. Can't get the original agent, can't compare your new generic to that original agent, can't get it approved by the FDA. Martin Shkreli's company did this in order to make it impossible for generic manufacture of pyrimethamine (Daraprim).

In fact, most of the drugs we're talking about here have been off-patent for DECADES. What's happened is that pharmaceutical companies, usually at the behest of venture (vulture) capitalists, realize that they've got mini-monopolies on these agents and why not raise the price? Who cares about mass suffering death and disease, there's PROFIT to be made!

Yeah, it is a little frustrating to read the comments and see everything getting lumped together. Most of the generic drug industry is actually one of the most functioning parts of the entire healthcare system in the U.S. For high volume drugs taken by lots of people the generic market is super competitive, and prices drop incredibly quickly as new companies enter the market for the drug.

The issue we have here is mostly with older drugs for smaller patient populations. Some of the problems are regulatory, as you mention. One of the issues had been that there were older generic drugs that have been on the market for pretty much ever, but never had any modern clinical trials done that would be needed for approval today. In order to encourage companies to do these trials, and get more accurate information about safety and efficacy, the FDA said they would give a period of market exclusivity to companies that did the work. This was always expected to raise prices somewhat, but people didn't foresee the Shkrelis of the world raising prices by thousands of percent (they should have, it was pretty predictable, but they didn't).

Other issues are more natural, where if you have a generic drug that is needed for only a few people, it generally doesn't make sense for there to be a ton of competitors producing it. So, maybe you've got two people making the drug, and then one of them has a problem with their factory, or the FDA shuts them down because they fail an inspection, or they go out of business, or whatever....and all of a sudden the other company realizes it has a monopoly and adjusts prices accordingly. Or, the original owners are more ethical, and don't do that, but a PE group notices and makes the owners an offer they can't refuse, and they raise the price. They can do that because, as Happy mentions, it is expensive to get some of these drugs approved and on to the market. The regulatory costs are fairly modest compared to a new drug, but still a lot, and setting up manufacturing can be costly too. Doesn't make sense to do that if the other guy can just quickly lower prices back down again if you enter the market.

Which is why something like the insurers getting into the game, and not naming which products they are going to manufacturer makes sense. It is more of a game theory credible threat to any would be generic monopolists, that hey, if you raise prices too high, we'll jump in...and we can afford to stay in the business longer than you can, and don't have to make money on the drugs, it will be enough if we can just stop other companies from raising prices. So, they'll be more than happy to put a small generic player out of business. At least that's my read of it, without having looked much into the details recently.

Unpopular opinion: health insurance companies get **more** than their fair share of blame. Why? Because they're at the consumer-facing end of a messed up system.

Don't get me wrong, US health insurance companies are super corrupt and very worthy of scorn. But frankly there are worse actors out there: hospitals that form regional monopolies, pharmaceutical companies that suppress research and lobby for anti-competitive regulation, and on and on. The problem is systemic.

I'm fine with either Medicare 4 All, like they have in the UK, or a centrist alternative like a public option with strong regulation, like they have in Germany or France. But I think the reason why M4A seems like the ONLY progressive option is because people mistakenly place the entire blame on only the insurance part instead of the whole screwed up system.

People who advocate Medicare 4 All have clearly never actually had to deal with Medicare and all its part A's, B's, C's and/or D's. Especially the latter.

SOP for pharmacuital companies at this point is to use a mix of advertising to convince people to not use the generic and "coupons" to make their drugs $0 or even negative-cost to consumers until the competition goes under due to lack of sales.

Indeed: if I'm charging $500/vial for insulin, and you are insured, and your co-pay is $50; I can send you a $100 rebate and come out $400 ahead.

Why would you buy the generic, even if it's free, when mine is -$50 and heavily advertised?

Elect an administration that acts on those anti-competitive practices, and a Congress that won't stonewall the enforcement.

Elect an administration that nationalizes health care and the problem goes away forever (because another administration can change those laws if people are retarded enough to do again what they did in electing this administration).

In fairness, this issue isn't solely on our current administration. It's on the willingness of the parties to go along with pharmaceutical lobby money. Hence why we need to nationalize the whole fucking thing.

You don't lobby for advantages when you don't have a private business to lobby for.

No, instead you get government bureaucrats making the same sort of cost-benefit analyses that Big Pharma does and discontinuing production of expensive exotic drug X because really, it's only needed by a few hundred people so not really worth it, the taxpayers will get more benefit elsewhere. Only this time, if you're one of those people who needs drug X, you have nowhere else to go to get it at any price.

Unpopular opinion: health insurance companies get **more** than their fair share of blame. Why? Because they're at the consumer-facing end of a messed up system.

Don't get me wrong, US health insurance companies are super corrupt and very worthy of scorn. But frankly there are worse actors out there: hospitals that form regional monopolies, pharmaceutical companies that suppress research and lobby for anti-competitive regulation, and on and on. The problem is systemic.

I'm fine with either Medicare 4 All, like they have in the UK, or a centrist alternative like a public option with strong regulation, like they have in Germany or France. But I think the reason why M4A seems like the ONLY progressive option is because people mistakenly place the entire blame on only the insurance part instead of the whole screwed up system.

People who advocate Medicare 4 All have clearly never actually had to deal with Medicare and all its part A's, B's, C's and/or D's. Especially the latter.

I advocate Medicare 4 All, I'm on Medicare Part A, B, C and D and it's the best coverage I've ever had.

I am all for less expensive medication but I am not a fan of generics because the quality is not the same. I'll give an example : I used to take Lipitor prior to the expiration of its patent. After the patent expired I began taking the generic substitute. With no other changes to medication or diet my glucose levels shot through the roof and I was prescribed an anti-diabetes medicine I can't remember the name of now. That led to a another change in medication that does not affect my glucose levels. I asked my doctor what was up with that and he said that is common with generic medications because they are usually made in India or China where the quality control is somewhere between lax and non-existent.

I am not convinced generic medication is really the answer but something certainly has to be done.

Here in the UK, generics are extremely common and made in places like India and Malta. I have never heard of any problems. Tell me, does you doctor ever get freebies from pharma companies?Spreading FUD was the IBM way of dealing with competition from more efficient vendors. In the long term it hasn't actually worked that well for them.

A few years ago now the UK government changed the rules so that nearly all NHS prescribing has to be of the generic. That way big pharma can't use a brand name to keep prices up on an out-of-patent drug. The only exception I have come across is where the drug company patented a new use for an existing drug, which then had to be prescribed by name when given for that use to avoid patent violation. Coupled with a fairly liberal approach to the licensing of generics and, mainly through the EU to be fair, a significant degree of recognition of other countries' manufacturing and quality control, prices have been held down.

I take several medications on a daily basis, and each time I get a new batch it is likely to be mae by a different manufacturer and come in a different box and a differently shaped and coloured tablet.

SOP for pharmacuital companies at this point is to use a mix of advertising to convince people to not use the generic and "coupons" to make their drugs $0 or even negative-cost to consumers until the competition goes under due to lack of sales.

Indeed: if I'm charging $500/vial for insulin, and you are insured, and your co-pay is $50; I can send you a $100 rebate and come out $400 ahead.

Why would you buy the generic, even if it's free, when mine is -$50 and heavily advertised?

Elect an administration that acts on those anti-competitive practices, and a Congress that won't stonewall the enforcement.

Elect an administration that nationalizes health care and the problem goes away forever (because another administration can change those laws if people are retarded enough to do again what they did in electing this administration).

In fairness, this issue isn't solely on our current administration. It's on the willingness of the parties to go along with pharmaceutical lobby money. Hence why we need to nationalize the whole fucking thing.

You don't lobby for advantages when you don't have a private business to lobby for.

No, instead you get government bureaucrats making the same sort of cost-benefit analyses that Big Pharma does and discontinuing production of expensive exotic drug X because really, it's only needed by a few hundred people so not really worth it, the taxpayers will get more benefit elsewhere. Only this time, if you're one of those people who needs drug X, you have nowhere else to go to get it at any price.

See also, SLS.

Then can you explain why almost the literal entire rest of the world does these things and people aren’t dying in the streets left right and center because of these death panels or whatever the current dog whistle against socialized medicine is?

Unpopular opinion: health insurance companies get **more** than their fair share of blame. Why? Because they're at the consumer-facing end of a messed up system.

Don't get me wrong, US health insurance companies are super corrupt and very worthy of scorn. But frankly there are worse actors out there: hospitals that form regional monopolies, pharmaceutical companies that suppress research and lobby for anti-competitive regulation, and on and on. The problem is systemic.

I'm fine with either Medicare 4 All, like they have in the UK, or a centrist alternative like a public option with strong regulation, like they have in Germany or France. But I think the reason why M4A seems like the ONLY progressive option is because people mistakenly place the entire blame on only the insurance part instead of the whole screwed up system.

People who advocate Medicare 4 All have clearly never actually had to deal with Medicare and all its part A's, B's, C's and/or D's. Especially the latter.

I know plenty of people who deal with Medicare and love it. I'm about to sign up next month. And from what I'm reading, the choices are better than many plans run by the for-profits - which is pretty much understandable for anyone good at math.

SOP for pharmacuital companies at this point is to use a mix of advertising to convince people to not use the generic and "coupons" to make their drugs $0 or even negative-cost to consumers until the competition goes under due to lack of sales.

Indeed: if I'm charging $500/vial for insulin, and you are insured, and your co-pay is $50; I can send you a $100 rebate and come out $400 ahead.

Why would you buy the generic, even if it's free, when mine is -$50 and heavily advertised?

Elect an administration that acts on those anti-competitive practices, and a Congress that won't stonewall the enforcement.

Elect an administration that nationalizes health care and the problem goes away forever (because another administration can change those laws if people are retarded enough to do again what they did in electing this administration).

In fairness, this issue isn't solely on our current administration. It's on the willingness of the parties to go along with pharmaceutical lobby money. Hence why we need to nationalize the whole fucking thing.

You don't lobby for advantages when you don't have a private business to lobby for.

Nationalizing health care doesn't exclude private enterprise from developing new medicines and treatments. Quite the opposite in the proposals that have been floated so far. There is ample room for entrepreneurialism under a single payer program.

The entry of Civica into the generics marketplace will be (I'm hoping) a disruptive force. The two big players in the current market (Teva and Perrigo) have not been acting in the interests of their customers, but rather their shareholders.

When a drug comes off patent, generics manufacturers often enter into a negotiation with the patent holder to determine how to proceed. If the generic manufacturer determines that the drug can be made for X and sold for Y, with a market of Z, then their gross profit will be roughly (Y-X)Z. Call that number "A".

The generics manufacturer may then offer the patent holder a deal: Pay us something near "A" and we will agree not to manufacture a generic. This is a deal that works for both parties when it comes to lower-volume products with a higher setup cost. For "blockbuster" products like Lipitor, Viagra, etc, the generic manufacturer will almost certainly enter the market.

So, part of the reason that the large generics manufacturers do not make a particular generic is because they make more money by not doing so. This leaves the lower-volume, higher-cost medication patents to be picked over by smaller, less efficient drug shops who are likely leveraging some in-house process that happens to fit the patent. So, these generics will cost more, or they may not be produced at all if the original patent holder determines that is simply costs too much to keep that process around.

Also, when you buy an off-patent medicine for which there is no generic, you are likely paying for not just the cost and profit of that medicine, but also for the cost of paying a generics manufacturer to stay out of the market. And yes, this is legal.

Civica, on the other hand, is chartered to manufacture generics, not to take money not to manufacture. So, fingers crossed for things getting better for everyone.

SOP for pharmacuital companies at this point is to use a mix of advertising to convince people to not use the generic and "coupons" to make their drugs $0 or even negative-cost to consumers until the competition goes under due to lack of sales.

Indeed: if I'm charging $500/vial for insulin, and you are insured, and your co-pay is $50; I can send you a $100 rebate and come out $400 ahead.

Why would you buy the generic, even if it's free, when mine is -$50 and heavily advertised?

Elect an administration that acts on those anti-competitive practices, and a Congress that won't stonewall the enforcement.

Elect an administration that nationalizes health care and the problem goes away forever (because another administration can change those laws if people are retarded enough to do again what they did in electing this administration).

In fairness, this issue isn't solely on our current administration. It's on the willingness of the parties to go along with pharmaceutical lobby money. Hence why we need to nationalize the whole fucking thing.

You don't lobby for advantages when you don't have a private business to lobby for.

No, instead you get government bureaucrats making the same sort of cost-benefit analyses that Big Pharma does and discontinuing production of expensive exotic drug X because really, it's only needed by a few hundred people so not really worth it, the taxpayers will get more benefit elsewhere. Only this time, if you're one of those people who needs drug X, you have nowhere else to go to get it at any price.

See also, SLS.

Then can you explain why almost the literal entire rest of the world does these things and people aren’t dying in the streets left right and center because of these death panels or whatever the current dog whistle against socialized medicine is?

Sure I can explain it. Do the math, you can explain it to yourself.

If a hundred people out of a population of 100 million are denied access to a life-saving drug, how obvious will it be that they are dying, even if it is "in the streets" (it won't be, of course). Plenty more people dying of other causes, those few will be lost in the noise. Which is fine for the bookkeepers, not so fine for those hundred individuals. But that doesn't matter. The good of the many outweighs the good of the few, or the one hundred. Too bad they didn't get a say in it.

Unpopular opinion: health insurance companies get **more** than their fair share of blame. Why? Because they're at the consumer-facing end of a messed up system.

Don't get me wrong, US health insurance companies are super corrupt and very worthy of scorn. But frankly there are worse actors out there: hospitals that form regional monopolies, pharmaceutical companies that suppress research and lobby for anti-competitive regulation, and on and on. The problem is systemic.

I'm fine with either Medicare 4 All, like they have in the UK, or a centrist alternative like a public option with strong regulation, like they have in Germany or France. But I think the reason why M4A seems like the ONLY progressive option is because people mistakenly place the entire blame on only the insurance part instead of the whole screwed up system.

People who advocate Medicare 4 All have clearly never actually had to deal with Medicare and all its part A's, B's, C's and/or D's. Especially the latter.

I know plenty of people who deal with Medicare and love it. I'm about to sign up next month. And from what I'm reading, the choices are better than many plans run by the for-profits - which is pretty much understandable for anyone good at math.

Um, many of those Medicare choices are run by the for-profits. Have you actually looked at the Part D paperwork?

Not that Medicare isn't better than some of the alternatives, but that's praising with faint damns, or something. It's pitiful that some people think it's the best we can come up with.

To this day I cannot believe there's a segment of the population in the USA who is opposed to Universal Healthcare the way they have it in Canada, England, Denmark et al.

We have Universal Health care in Mexico. It has lots of issues. Plenty, to be honest. But it's way better than not having anything and having to rely on private insurance when you get sick.

I've seen how bad poor people in the USA have it when they don't have insurance, and to me that's insane. It really makes the USA look worst than a developing country (such as Mexico).

Some of that segment has actually lived in Canada, or England, or Denmark et al. Me, for example.

"Not having anything" and "relying on private insurance" are mutually contradictory. If you have private insurance, you have something, often a pretty good something. But why would you know that, you live somewhere with Universal Health Care.

What is to stop the company from releasing drugs at just under what the cheapest drugs are at, and then selling them for that price? Does BCBS get a cut of the profits from the drugs that are manufactured? If even 10% of the cost of the drug is given back to BCBS, then if they sell a drug for $100, they get $10 back... For the same drug they purchased and made. And then if other insurance providers pay for the same drugs, BCBS gets the 10% from them too.

I understand the company was created because of the price increases, but I think there is also the bottom line that will eventually be what the Board will stress.

Will this turn into the Insurance companies all getting into the game of partnering with drug companies to make the drugs and get a part of the profits? If so, then what is to stop them from price gouging and reaping the rewards.

Like many things involving insurance and US healthcare... I remain cautiously... um... hopeful? But realistically bummed at what will inevitably happen.

Maybe I am just pessimistic about the world. But with the track record - FCC shenanigans, IoT products becoming bricks, the current farce in the White House and the current proceedings - it is hard for me to be optimistic.

Disclaimer: I work in pharmaceutical drug pricing and reimbursement

CivicaRx works differently from other drug manufacturers because it is not actually a manufacturer - at this stage they are in drug manufacturing contracting and re-labeling. Manufacturing takes years to set up, and the company has not yet determined that it is necessary to go into production on its own. Instead what it does is identify drugs that have gone up in pricing or are in shortage due to reasons other than ingredient shortages, and contracts with manufacturers to establish a steady supply at a transparent price. Generic drug manufacturers stop producing drugs when they are no longer assured of enough demand to make production profitable. CivicaRx addresses this by having it's 1200+ member hospitals agree to purchase the drugs produced under contract. Both sides benefit - hospitals get a sure supply of low-cost medication while the manufacturer gets a multi-year purchase guarantee to keep the production lines rolling.

The hospitals and BCBS aren't looking to profit from this venture - this is about establishing a reliable supply and a low, transparent price. Other manufacturers may lower their prices below what CivicaRx is charging, but there is no guarantee those prices will remain low or that the products will continue to be made. So BCBS isn't looking to make $$ on each sale, but instead to SAVE money on the use of drugs in the hospital setting. While CivicaRx may eventually expand its product availability to other providers, at the moment they are focused on the hospital setting. Remember that Civica is a non-profit - their focus is not on making money but instead on ensuring adequate supplies at reasonable prices.

As to your question about insurance companies partnering with manufacturers - this already happened in the past. A lot of PBMs (pharmacy benefit managers) originated with drug manufacturers, and those that didn't start their own bought them. The FTC started investigating this in the 90s, however, and so seeing the writing on the wall all the drug companies divested themselves of their PBM subsidiaries. Whether or not the government would let a manufacturer own a PBM or vice-versa is probably less of a concern, however, as no PBM would want to own a manufacturer. PBMs make the most money by playing drug manufacturers against each other, and generic drug manufacturing is not a low-riskm high-margin business.

Instead we've seen PBMs partner with wholesalers to form buying groups to source generic drugs at discount prices. The two major programs are Red Oak Sourcing, owned by CVS/Health and Cardinal Health, and Alliance Boots Development owned by Walgreens and AmeriSourceBergen, which also includes participation from Express Scripts. Walmart also has a program with McKesson. Between these three programs you have the three biggest biggest retail pharmacy chains and three largest drug wholesalers, as well as the two biggest PBMs. Insurance companies are already part of these arrangements due to Express Scripts being owned by Cigna as of last year and CVS/Health's acquisition of Aetna. In addition, Anthem uses CVS/Health for it's PBM backend.

Unpopular opinion: health insurance companies get **more** than their fair share of blame. Why? Because they're at the consumer-facing end of a messed up system.

Don't get me wrong, US health insurance companies are super corrupt and very worthy of scorn. But frankly there are worse actors out there: hospitals that form regional monopolies, pharmaceutical companies that suppress research and lobby for anti-competitive regulation, and on and on. The problem is systemic.

I'm fine with either Medicare 4 All, like they have in the UK, or a centrist alternative like a public option with strong regulation, like they have in Germany or France. But I think the reason why M4A seems like the ONLY progressive option is because people mistakenly place the entire blame on only the insurance part instead of the whole screwed up system.

People who advocate Medicare 4 All have clearly never actually had to deal with Medicare and all its part A's, B's, C's and/or D's. Especially the latter.

I advocate Medicare 4 All, I'm on Medicare Part A, B, C and D and it's the best coverage I've ever had.

That doesn't say much about your previous coverage.

(Also, if you really are on all four parts, you're probably (not necessarily) paying for something you don't need. And Part C is by private companies, not the feds, although the companies have to be Federally approved.)

You know what? People are already dying due to bookkeepers marking a line. Its just that currently the line is drawn by people that want to MAKE MORE MONEY by that loss of life. There will have to be some system for rationing care. You cannot spend the entire GDP to try to save the life of the current sickest person in the country. Anything less than that is rationing care. Currently its rationed poorly primarily via some wacky mixture of insurance protocols and the decisions of the people deciding to forgo their offsprings education to grant grandma another 5 days of ER coverage.

Unpopular opinion: health insurance companies get **more** than their fair share of blame. Why? Because they're at the consumer-facing end of a messed up system.

Don't get me wrong, US health insurance companies are super corrupt and very worthy of scorn. But frankly there are worse actors out there: hospitals that form regional monopolies, pharmaceutical companies that suppress research and lobby for anti-competitive regulation, and on and on. The problem is systemic.

I'm fine with either Medicare 4 All, like they have in the UK, or a centrist alternative like a public option with strong regulation, like they have in Germany or France. But I think the reason why M4A seems like the ONLY progressive option is because people mistakenly place the entire blame on only the insurance part instead of the whole screwed up system.

People who advocate Medicare 4 All have clearly never actually had to deal with Medicare and all its part A's, B's, C's and/or D's. Especially the latter.

I advocate Medicare 4 All, I'm on Medicare Part A, B, C and D and it's the best coverage I've ever had.

That doesn't say much about your previous coverage.

(Also, if you really are on all four parts, you're probably (not necessarily) paying for something you don't need. And Part C is by private companies, not the feds, although the companies have to be Federally approved.)

No, my previous plans were crap. They were also what private employers were giving me for coverage because they're cheap sons of bitches and don't want to pay for it. So your argument is invalid thinking they can do it better.

And Part C is administered by private companies, who have the Federal Government telling them exactly what to do and how to do it, so we're back to discussing how the government provides healthcare.

The simple fact is there's about 6 billion people in the world whose health care comes more or less directly from their government and they're not begging to go back to a system like the US has. (The rest live in literal anarchy, utterly broke nations and the United States.) It's almost like it works better...

I am all for less expensive medication but I am not a fan of generics because the quality is not the same. I'll give an example : I used to take Lipitor prior to the expiration of its patent. After the patent expired I began taking the generic substitute. With no other changes to medication or diet my glucose levels shot through the roof and I was prescribed an anti-diabetes medicine I can't remember the name of now. That led to a another change in medication that does not affect my glucose levels. I asked my doctor what was up with that and he said that is common with generic medications because they are usually made in India or China where the quality control is somewhere between lax and non-existent.

I am not convinced generic medication is really the answer but something certainly has to be done.

maybe your glucose levels shot up because you eat shit and it finally caught up with you? switching to a generic is a correlation, not a causation.

What is to stop the company from releasing drugs at just under what the cheapest drugs are at, and then selling them for that price? Does BCBS get a cut of the profits from the drugs that are manufactured? If even 10% of the cost of the drug is given back to BCBS, then if they sell a drug for $100, they get $10 back... For the same drug they purchased and made. And then if other insurance providers pay for the same drugs, BCBS gets the 10% from them too.

I understand the company was created because of the price increases, but I think there is also the bottom line that will eventually be what the Board will stress.

Will this turn into the Insurance companies all getting into the game of partnering with drug companies to make the drugs and get a part of the profits? If so, then what is to stop them from price gouging and reaping the rewards.

Like many things involving insurance and US healthcare... I remain cautiously... um... hopeful? But realistically bummed at what will inevitably happen.

Maybe I am just pessimistic about the world. But with the track record - FCC shenanigans, IoT products becoming bricks, the current farce in the White House and the current proceedings - it is hard for me to be optimistic.

The bottom line of BCBS is fixed. 80% of premium spend MUST be on healthcare. It is the law. These dollars are coming from the 80%, not the 20%.

Unpopular opinion: health insurance companies get **more** than their fair share of blame. Why? Because they're at the consumer-facing end of a messed up system.

Don't get me wrong, US health insurance companies are super corrupt and very worthy of scorn. But frankly there are worse actors out there: hospitals that form regional monopolies, pharmaceutical companies that suppress research and lobby for anti-competitive regulation, and on and on. The problem is systemic.

I'm fine with either Medicare 4 All, like they have in the UK, or a centrist alternative like a public option with strong regulation, like they have in Germany or France. But I think the reason why M4A seems like the ONLY progressive option is because people mistakenly place the entire blame on only the insurance part instead of the whole screwed up system.

People who advocate Medicare 4 All have clearly never actually had to deal with Medicare and all its part A's, B's, C's and/or D's. Especially the latter.

I advocate Medicare 4 All, I'm on Medicare Part A, B, C and D and it's the best coverage I've ever had.

That doesn't say much about your previous coverage.

(Also, if you really are on all four parts, you're probably (not necessarily) paying for something you don't need. And Part C is by private companies, not the feds, although the companies have to be Federally approved.)

No, my previous plans were crap. They were also what private employers were giving me for coverage because they're cheap sons of bitches and don't want to pay for it. So your argument is invalid thinking they can do it better.

And Part C is administered by private companies, who have the Federal Government telling them exactly what to do and how to do it, so we're back to discussing how the government provides healthcare.

The simple fact is there's about 6 billion people in the world whose health care comes more or less directly from their government and they're not begging to go back to a system like the US has. (The rest live in literal anarchy, utterly broke nations and the United States.) It's almost like it works better...

I have never had 'crap' insurance. I have had high deductibles, yes, but typically my employers have provided and contributed to an HSA on my behalf. My current health plan gives me free access to mental health services, something that Canadians have to pay for. It also has a deductible of $300.

Edit: let me add that, despite having 6 surgeries and nearly dying within the past 3 years (septic shock), I have paid only around $1,500 in Heath care costs excluding insurance premiums ranging between $120 and $230 a month (employer change).

I am all for less expensive medication but I am not a fan of generics because the quality is not the same...

Someone else addressed what your doctor told you, but I'll address this part. I have been taking two different blood pressure medications now for nearly fifteen years. I only take generics of both and my pharmacy uses different generic companies for their supply as prices fluctuate. In a given year I probably have at least a month's worth of each drug from two to three different generic manufacturers. My blood pressure stays perfectly under control through all of this, even in high-stress situations like a severe kidney-stone attack. (I've seen insanely high blood pressure readings at ER visits in the past before I was put on blood pressure meds.)

I also take three different drugs for my interstitial cystitis, and two of those are generics. (The third is still under patent protection.) Again, they keep the cystitis under control even as the generic manufacturers switch over the course of the year. I've gone from such severe IC that I averaged getting up to pee six times a night (worst night ever was twelve times, and quite miserable) to only getting up once most nights. In this case the quality of the generics is not only just as good as name-brand, they have improved the quality of my life noticeably.

There's other medications I take as well, no problems over the course of years despite the fact that only one drug of the whole lot is non-generic. The quality of generics is just fine, and anyone saying otherwise (including your doctor) are wrong.

I am all for less expensive medication but I am not a fan of generics because the quality is not the same. I'll give an example : I used to take Lipitor prior to the expiration of its patent. After the patent expired I began taking the generic substitute. With no other changes to medication or diet my glucose levels shot through the roof and I was prescribed an anti-diabetes medicine I can't remember the name of now. That led to a another change in medication that does not affect my glucose levels. I asked my doctor what was up with that and he said that is common with generic medications because they are usually made in India or China where the quality control is somewhere between lax and non-existent.

I am not convinced generic medication is really the answer but something certainly has to be done.

I would bet that whatever sent your blood glucose up, it was not an impurity in generic atorvastatin. Yes, the generics have been caught falsifying QC on occasion, but we are talking about things like the 0.04% impurity, which was 0.06% in their batches, and by regulation now has to be identified. Or 12 ppm palladium instead of <10 ppm. Certainly not good practices today, but would have been state of the art 40 years ago.

I am all for less expensive medication but I am not a fan of generics because the quality is not the same. I'll give an example : I used to take Lipitor prior to the expiration of its patent. After the patent expired I began taking the generic substitute. With no other changes to medication or diet my glucose levels shot through the roof and I was prescribed an anti-diabetes medicine I can't remember the name of now. That led to a another change in medication that does not affect my glucose levels. I asked my doctor what was up with that and he said that is common with generic medications because they are usually made in India or China where the quality control is somewhere between lax and non-existent.

I am not convinced generic medication is really the answer but something certainly has to be done.

I would bet that whatever sent your blood glucose up, it was not an impurity in generic atorvastatin. Yes, the generics have been caught falsifying QC on occasion, but we are talking about things like the 0.04% impurity, which was 0.06% in their batches, and by regulation now has to be identified. Or 12 ppm palladium instead of <10 ppm. Certainly not good practices today, but would have been state of the art 40 years ago.

Brand manufacturers have been caught with similar kinds of flaws. Schering Plough once had an entire lot of Proventil inhalers sent out that lacked any of the active ingredient.

I am all for less expensive medication but I am not a fan of generics because the quality is not the same...

Someone else addressed what your doctor told you, but I'll address this part. I have been taking two different blood pressure medications now for nearly fifteen years. I only take generics of both and my pharmacy uses different generic companies for their supply as prices fluctuate. In a given year I probably have at least a month's worth of each drug from two to three different generic manufacturers. My blood pressure stays perfectly under control through all of this, even in high-stress situations like a severe kidney-stone attack. (I've seen insanely high blood pressure readings at ER visits in the past before I was put on blood pressure meds.)

I also take three different drugs for my interstitial cystitis, and two of those are generics. (The third is still under patent protection.) Again, they keep the cystitis under control even as the generic manufacturers switch over the course of the year. I've gone from such severe IC that I averaged getting up to pee six times a night (worst night ever was twelve times, and quite miserable) to only getting up once most nights. In this case the quality of the generics is not only just as good as name-brand, they have improved the quality of my life noticeably.

There's other medications I take as well, no problems over the course of years despite the fact that only one drug of the whole lot is non-generic. The quality of generics is just fine, and anyone saying otherwise (including your doctor) are wrong.

I am a pharmacist. I take generic drugs whenever I can get them. Both brand manufacturers and generic manufacturers have had issues on occasion. So you blanket statement is slightly excessive but in a general sort of way it is true. Generic manufacturers must show blood levels equal to those of the branded product. The product cannot exceed 10% variance ie it must contain between 90 and 110% of the stated drug (which is also the brand product interlot allowable). As a general rule get generics whenever possible unless your pharmacist disagrees. One caveat, occasionally a generic will have an inactive ingredient that a person is allergic to that is NOT in the brand product, but the reverse might also be true.

I said several months ago to some friends if I had billionaire type money I would start a non-profit generic pharma company. If for no other reason than to stick it to people that jack up the price of $5 pills to $500 pills.

I wonder who will decide which pill you get at the hospital? As it stands you pretty much sign away everything upon admittance and pray they use "in network" doctors, covered labs and generic meds, but it's not like you have any information about what you will be billed for how much or even who will be billing you.

This is probably a step in the right direction but I am weary that instead of reducing patient costs or premiums it will simply shift margin. But hey, it's one less link in the chain so it's worth a shot!

Unpopular opinion: health insurance companies get **more** than their fair share of blame. Why? Because they're at the consumer-facing end of a messed up system.

Don't get me wrong, US health insurance companies are super corrupt and very worthy of scorn. But frankly there are worse actors out there: hospitals that form regional monopolies, pharmaceutical companies that suppress research and lobby for anti-competitive regulation, and on and on. The problem is systemic.

I'm fine with either Medicare 4 All, like they have in the UK, or a centrist alternative like a public option with strong regulation, like they have in Germany or France. But I think the reason why M4A seems like the ONLY progressive option is because people mistakenly place the entire blame on only the insurance part instead of the whole screwed up system.

People who advocate Medicare 4 All have clearly never actually had to deal with Medicare and all its part A's, B's, C's and/or D's. Especially the latter.

I advocate Medicare 4 All, I'm on Medicare Part A, B, C and D and it's the best coverage I've ever had.

That doesn't say much about your previous coverage.

(Also, if you really are on all four parts, you're probably (not necessarily) paying for something you don't need. And Part C is by private companies, not the feds, although the companies have to be Federally approved.)

No, my previous plans were crap. They were also what private employers were giving me for coverage because they're cheap sons of bitches and don't want to pay for it.

So we agree that your previous plans are a poor baseline against which to judge Medicare.

Quote:

So your argument is invalid thinking they can do it better.

That doesn't follow. Firstly, that was never my argument, secondly, your personal experience with crappy employers and their coverage is hardly exemplary of everyone's employer coverage or private plans. But sure, it's all about you.